Tracheostomy in children: There is a place for acceptable risk

Background: Tracheostomy in children remains controversial regarding the ri sk of complications. Methods: Forty-six trauma patients (35 male and 11 female, mean age = 6.8 y ears) were admitted to the intensive care unit between 1987 and 1991 with s evere head injury plus coma. Tracheostomy was performed with standard techn ique after 5.9 days (range, 2-12 days) of intubation, Results There were no deaths from tracheostomy, but six deaths resulted fro m severe head injury. One child was discharged with tracheostomy, The 39 su rvivors remained with tracheostomy 16.14 days (range, 4-71 days) in the int ensive care unit. After cannula removal, 31 remained asymptomatic; 8 had re spiratory distress: 2 were normal, 5 had endoscopic treatment for subglotic granulomas/stenosis from intubation, and 1 had tracheomalacia from tracheo stomy, In 1997, the 18 patients located for follow-up were asymptomatic. At endoscopy, 8 were normal, 9 had subglottal granulomas from intubation, and 1 had 20% tracheal stenosis from tracheostomy, Conclusion: Most complications after tracheostomy result from intubation, T racheostomy has an acceptable risk in children with severe head injury who need prolonged ventilatory support.